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Review Article z Available online at http://www.journalcra.com INTERNATIONAL JOURNAL OF CURRENT RESEARCH International Journal of Current Research Vol. 8, Issue, 12, pp.42929-42932, December, 2016 ISSN: 0975-833X REVIEW ARTICLE ENTHRALLING SIGNS - A KEY TO DIAGNOSIS *Deepika Meesala, Talla Harshavardhan, Nimma Vijayalaxmi and Madhulatha Gopaladas Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India ARTICLE INFO ABSTRACT Article History: Certain signs manifested in head and neck region including oral cavity serve as an imperative clue in diagnosing systemic disorders. The visibility of these signs often enables the physician to make an Received 03rd September, 2016 Received in revised form instant or spot diagnosis. The word diagnosis means ―thorough knowledge, it is the greatest task and 16th October, 2016 a key to successful clinical practice. Hence a thorough knowledge regarding various presenting signs Accepted 20th November, 2016 and symptoms is of utmost importance to a clinician for precise diagnosis and management of a Published online 30th December, 2016 disease. This present article reviews various fascinating ―SIGNS” which in medical lexicon refers to an objective physical finding observed by an examiner. Only signs that are visible, palpable, or Key words: elicited by direct manipulation, and dermatologic signs associated with oral involvement are included herein. Cutaneous signs, Oral signs, Oral manifestations, Systemic disorders. Copyright©2016, Deepika Meesala et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Citation: Deepika Meesala, Talla Harshavardhan, Nimma Vijayalaxmi and Madhulatha Gopaladas, 2016. “Enthralling signs - A key to diagnosis”, International Journal of Current Research, 8, (12), 42929-42932. INTRODUCTION Working Classification: A symptom is any subjective evidence of disease, while Category Example Oral signs Nikolsky sign, Asboe hansen sign, Sheklakov sign, a sign is any objective evidence of disease. Therefore, a Epidermal peeling sign, Lutz sign, coleman’s sign, symptom is a phenomenon that is experienced by the battle sign, Guerin sign. individual affected by the disease, while a sign is a Cutaneous signs Auspitz’s sign, Carpet Tack Sign, Oil Drop Sign, phenomenon that can be detected by someone other than the darier’s sign, string of beads sign, forsccheimer’s sign, cluster of jewels sign, gottron sign, shawl’s individual affected by the disease. (Definition: 'Sign' 2013) sign, hutchinson’s sign, pastia’s sign, Crowe sign, The art of interpreting clinical signs was originally called Dimple sign, borsari’s sign “semiotics” means “to do with signs” was first used in English Radiographic Tear drop sign. in 1670 by Henry Stubbes. (Stubbe, 1670) These signs go a signs long way in establishing a clinical diagnosis or else judge the severity of disease in an individual patient. Google search was Signs as Kernig’s sign, brudzinski sign, von grafe sign, done using the terminology cutaneous signs, oral signs, signs manifestation of koche’s sign, dalrymple sign, laser sign, russels sign, manifested by systemic diseases. Some of the most important systemic disease psoas sign, gorlin sign, dubois sign, Higoumenakis Sign, hoagland’s sign, jellinek’s sign. ones among these are discussed here for the benefit of medical Miscellaneous Hoffman’s sign, double ring sign, raccoon sign students. signs Discussion 2.Asboe hansen sign/ indirect Nikolsky sign/ Nikolsky II sign: it is demonstrated as extension of a blister to adjacent 1.Nikolsky sign: it is defined as a slight pressure on normal normal unblistered skin when pressure is put on the top of the appearing skin or mucosa leads to formation of blister. As the bulla. (Kaur et al., 1987) skin shows a weakening relationship and contact between the Ex: pemphigus vulgaris, acute bullous lichen planus. corneal (horny) and granular layers on all surfaces even in places between the lesions. (Sachdev, 2003) 3.Sheklakov sign/ false nikolsky/ marginal sign: This Ex: pemphigus vulgaris, toxic epidermal necrolysis. involves pulling the peripheral remnant of a roof of a ruptured blister, thereby extending the erosion on the surrounding *Corresponding author: Deepika Meesala, normal appearing skin. It is called the "false Nikolskiy" sign Department of Oral Medicine and Radiology, Meghna Institute of Dental Sciences, Nizamabad, Telangana, India because it is a subepidermal cleavage occurring in the perilesional skin. (Grando et al., 2003) 42930 Deepika Meesala et al. Enthralling signs - A key to diagnosis Ex: bullous pemphigoid, cicatricial pemphigoid, epidermolysis responsible for the response seen after rubbing the skin. (Amar bullosa acquisita. (Grando et al., 2003) Surjushe et al., 2007) Ex: systemic mastocytosis or urticaria pigmentosa 4.Epidermal peeling sign/ pseudo nikolsky sign: refers to the ability to peel off the entire epidermis by lateral pressure 13.String of beads sign - The classic primary lesions of linear (rubbing) only on the erythematous skin areas; underlying IgA dermatosis are clear and/or hemorrhagic round or oval mechanism here is the necrosis of epidermal cells and not vesicles or bullae on normal, erythematous, or urticarial skin. acantholysis as in true Nikolskiy sign. (Fritsch et al., 1999) New vesicles seen developing at the edge of annular or Ex: Stevens-Johnson syndrome, toxic epidermal necrolysis polycyclic lesions, the appearance of which has been described as the string of beads sign. (Billet et al., 2008) 5.Lutz sign/bulla spread sign: it refers to Slow, careful and Ex: linear immunoglobulin IgA dermatosis unidirectional pressure applied by a finger to the bulla causes peripheral extension of the bulla beyond the marked margin. 14.Forsccheimer’s sign- a fleeting enanthem seen as small, (Sentamilselvi Ganapati, 2014) red spots (petechiae) or reddish maculopapular eruption on Ex: pemphigus and subepidermal blisters. (Sentamilselvi the soft palate. They precede or accompany the skin rash. Ganapati, 2014) (Tait et al., 1996) Ex: german measles (rubella). 6.Coleman’s sign: an effusion of blood into the (tissues of the) floor of the mouth, raising its mucous membrane and 15.Cluster of jewels sign/rosettes sign: It refers to Round or producing a characteristic bluish, tense swelling under the oval blisters filled with clear fluid may arise from normal- tongue. (Frank coleman, 1912) looking skin or from red flat or elevated patches. Typically, the Ex: fracture of the body of the mandible. blisters are arranged in rings (annular lesions) and they may form a target shape. groups of small blisters may be described 7.Battle sign: bruising over the mastoid process as a result of as a cluster of jewels. (Kakar et al., 2013) extravasation of blood along the path of the posterior auricular Ex: linear immunoglobulin IgA dermatosis artery and may suggest underlying brain trauma. (Naumann, Hans Heinz and Jan Helms, 1998) 16.Gottron’s sign: an erythematous and scaly eruption Ex: fracture of middle cranial fossa of the skull. occurring in symmetrical fashion seen on the dorsum of the hand, over the metacarpophalngeal and proximal interphalngal 8.Guerin sign: Ecchymosis or bruising in the palate in the joints with characteristic skin/cutaneous manifestations and region of greater palatine vessels. It is thought to be due to symmetric proximal muscle weakness accompanied by pain. damage to the greater palatine vessels as a result of facial (Prashanth Sunkureddi et al., 2005) trauma causing low level fracture involving maxilla. Ex: dermatomyositis. Ex: Lefort I fractures. (Karim Kassam and Mahesh Kumar, 2014) 17.Shawl’s sign/V-sign: It is a diffuse, flat, erythematous lesion over the back and shoulders or in a “v” over the 9.Auspitz’s sign: refers to the appearance of punctate bleeding posterior neck and back or neck and upper chest, which spots when psoriasis scales [Buckley’s membrane] are scraped worsens with UV light. (Prashanth Sunkureddi et al., 2005) off or removed. This happens because there is thinning of the Ex: dermatomyositis. epidermal layer overlying the tips of the dermal papillae and dilatation of subpapillary dermal blood vessels, which bleed 18.Hutchinson’s sign: vesicles on the tip of the nose, or readily when the scale is removed. (Holubar, 2003) vesicles on the side of the nose, precedes the development of Ex: psoriasis. the ophthalmic herpes zoster. This occurs because the nasociliary branch of the trigeminal nerve innervates both the 10.Oil-drop sign: Circular areas of discoloration of nail bed cornea and the lateral dorsum of the nose as well as tip of the and hyponychium occur as a result of involvement of these nose. (Baran and Kechijian, 1996) structures in psoriasis. As these areas resemble oil drops below Ex: herpes zoster the nail, hence the name of oil-drop sign. (Imran Majid, 2006) Ex: psoriasis of nails 19.Pastia’s sign/ thompson’s sign: a clinical sign in which pink or red lines formed of confluent petechiae are found in 11.Tin-tack sign/carpet tack sign: Removal of an adherent skin creases, particularly the crease in the antecubital fossa, the scale from a lesion of DLE reveals the undersurface to be soft inside depression on the inside of the arm. (Rapini et al., covered with horny plugs [resembling carpet tacks] overlying 2007) dilated hair follicular openings. Hyperkeratotic scales Ex: scarlet fever extending into the follicular infundibulum creates keratotic spikes when viewed from the scale‘s undersurface resembling 20.Crowe sign: presence of axillary (armpit) freckling in a carpet tack. (Baba et al., 2001) people with neurofibromatosis type I (von Recklinghausen’s Ex: Discoid Lupus Erythematosus [DLE]. disease). (Jett and Friedman, 2010) 12.Darier’s sign: a change observed after stroking the skin of 21.Dimple sign/Fitzpatrick’s sign: a dermatological sign with a person as it becomes swollen, itchy and red. This is a result characteristic tethering of the overlying epidermis to the of compression of mast cells, which are hyperactive in these underlying lesion with lateral compression (pinching).
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